In dispensaries, we are also focusing on non-communicable diseases (NCDs) in addition to communicable diseases. Due to urban lifestyle, cases of NCDs are steadily rising. We have undertaken diabetes programmes since 2011. We have more than 72 dispensaries where monitoring is done, says Dr Padmaja Keskar, Executive Health Officer, Municipal Corporation of Greater Mumbai (MCGM), in conversation with Harshal Yashwant Desai of Elets News Network (ENN).
Q: As an executive health officer, give us an overview of primary job responsibilities assigned by the MCGM.
Primary Healthcare in Mumbai city is one of the basic duties, and it is obligatory duty of Municipal Corporation as well. Under this, earlier, we had 175 dispensaries – recently 11 new PHCs have been added taking the total number to 186 dispensaries, located in different areas of Mumbai corporation. These dispensaries help us in providing quick OPD services to patients. If additional care is required, we refer them for secondary or tertiary care at peripheral or major hospitals of MCGM.
Besides, we have 28 maternity homes. Here, antenatal checkups, delivery services and post-natal checkups are provided.
We also have 210 health posts which provide outreach services. All the immunisation, control of communicable diseases, and family welfare activities are undertaken at these health posts. These posts are very crucial for reaching out to communities.
Health posts are managed by one assistant medical officer, one public health nurse, auxiliary nurses and coordinators, and 20 CHVs (community health volunteers). They go door-to-door and consult and educate people on their health issues. They undertake field immunisation camps, family welfare camps and activities for communicable and non-communicable diseases.
Q: Do you also undertake and implement national programmes? Please brief us.
Yes. We undertake all the national programmes, like vector control programmes, leprosy, TB, HIV and immunisation. All these programmes are implemented by this department. Then the execution of various acts including PC-PNDT act, MTP Act under which we give registration to all the imaging equipment and institutions which deals in such instrument we register all private nursing homes under Bombay Nursing Home Registration Act.
We register all the vital events including birth and death. There are cemeteries in Mumbai — municipal and private. Municipal cemeteries are maintained by us. MCGM is the first to start a PNG crematorium in the State.
Q: What recent initiatives have been undertaken by you in primary healthcare?
In dispensaries, now we are also focusing on non-communicable diseases in addition to communicable diseases. Due to urban lifestyle, cases of non-communicable diseases are increasing in a fast manner. We have undertaken diabetes programmes since 2011. We have more than 72 dispensaries where monitoring is done. Patient list is maintained and dieticians are made available who visit once in a week to provide diet counselling. Minor investigations are being made available at dispensary-level.
For communicable diseases, there are programmes going on for preventive aspect. We do undertake mosquito abetment committee to prevent disease by reducing breeding sites. To control malaria and dengue, SOPs (standard operating procedures) were prepared. This has resulted in a steady decline in the number of such cases. We also have established EPID Cell which collects reports from private and government hospitals via emails. All the reports are analysed at EPID Cells and communicated to all the medical officers of health. Then they take invention at residential sites to prevent any disease from flaring up further.
Some of the major functions of EPID Cells are:
• Collect, compile and analyse the data on various epidemic prone diseases for surveillance
• Inform the local health authority for rapid response to prevent or control spread of diseases in the communities.
• Coordinate with Health and Non Health Department for prevention and control of communicable diseases and outbreaks.
• Update the Higher Authority about the Disease Situation in Mumbai.
• Update the Media regarding Disease Situation Fortnightly/Weekly.
• Assists Training Cell, MCGM by providing resource person and resource materials for training and sensitisation of Medical, paramedical staff and Private Medical Practitioners.
Q: What about measures to control Leptospirosis?
For leptospirosis, we have undertaken chemoprophylaxis, which has yielded very good results. Chemoprophylaxis treatment is given to affected patients within 72 hours of infection which increases chance of survival of the patients. One of our major health problems is TB, an airborne disease. There are TB sensitive cases, drug resistant cases. We have GTB hospitals, which is 1,200-bedded hospital, where 200 beds are reserved for drug resistant cases. AIC (Airborne Infection Control) measures are being followed properly here.
Under PPSA, private practitioners are involved in our programmes and RNDCP programmes are going on under which we provide free medication, free diagnosis. We have tied-up with laboratories and NGOs for the same. Nutrition is given to drug resistant TB patients.
For HIV also, we are getting free treatment and investigations from the Government of India. There is Enhanced Adherence Counselling (EAC) programme under which high risk patients are segregated. 14 ART centres are established across Mumbai. As per number of cases and types of cases, geo-prioritisation is adopted. Mobile application has been developed also to cater such patients also.
Q: What are the challenges you face?
Health is not priority for Indian communities. They are least bothered about their health. We have to convince people to make them aware about TB, HIV and other issues and health problems. We have seen that public response for awareness campaign is also unsatisfactory. The Public Health Department is constantly working on addressing these challenges.